Transoral robotic surgery(TORS)is a minimally invasive technique for resection of tumors of the posterior pharyngeal wall.Rarely,post-TORS cervical spondylodiscitis has been reported in the literature,with high morbid...Transoral robotic surgery(TORS)is a minimally invasive technique for resection of tumors of the posterior pharyngeal wall.Rarely,post-TORS cervical spondylodiscitis has been reported in the literature,with high morbidity and mortality.A 64-year-old female with underlying cervical disk disease underwent TORS resection of a posterior pharyngeal wall carcinoma without reconstruction in April 2020.Roughly one month post-operatively,the patient presented with clinical and radiographic signs of spondylodiscitis,epidural abscess,and meningitis.The patient was treated with antibiotic therapy and anterior cervical discectomy and fusion.The patient recovered without neurologic deficit.A three-month post-treatment PET-CT scan showed no evidence of residual disease.Post-operative cervical spondylodiscitis and meningitis are rare complications of TORS resection for posterior pharyngeal wall carcinomas,but the risk is increased in patients with underlying cervical disk disease.In such patients,perioperative antibiotic treatment and/or reconstruction should be considered to prevent neurologic complications and death.展开更多
BACKGROUND The purpose of open reduction and internal fixation of acetabulum posterior wall fractures is to restore anatomical structure and stability of the hip joint, in order to start weight bearing as soon as poss...BACKGROUND The purpose of open reduction and internal fixation of acetabulum posterior wall fractures is to restore anatomical structure and stability of the hip joint, in order to start weight bearing as soon as possible and prevent hip arthrosis; restoration of the anatomy should preserve function of the joint as well. Although "special shaped precontoured plates" have been developed in recent years for surgical treatment of this region, studies comparing the traditional plates with the newly designed precontoured plates are lacking.AIM To evaluate the biomechanical properties of precontoured anatomic buttress and conventional curved reconstruction plates(CCRPs) for posterior wall acetabulum fracture treatment.METHODS Twelve pelvis models were created for testing plate treatment of fracture in the posterior wall of the acetabulum. These 12 pelvis models were used to create 24 hemipelvis models(experimental) by cutting from the sagittal plane and passing over the center of gravity, after which the posterior wall acetabular fractures(of similar type and size) were created. In these experimental models, the right acetabulum was fixed with a 5-hole CCRP, while the left was fixed with a precontoured anatomic buttress plate(PABP). Samples were placed through thetest device and were subjected to static load testing, with a constant testing velocity of 2 mm/min until the load reached 2.3 kN or the acetabular fixation failed. Dynamic tests were also performed with sinusoidal wave load, with a maximal load of 2.3 kN and a load ratio of 0.1.RESULTS The average stiffness values were 460.83 ± 95.47 N/mm for the PABP and 291.99± 118.58 N/mm for the 5-hole CCRP. The precontoured anatomic acetabulum buttress plates had significantly higher rigidity than the CCRPs(P = 0.022). There was a statistically significant difference between the unloaded and 2.3 kN-loaded values of AL(posterosuperior fracture line vertical to the ground surface) and CL(posteroinferior fracture line vertical to the ground surface) parameters for both the PABPs and the 5-hole CCRPs(P = 0.036 and P = 0.045, respectively).According to the static tests, the amount of total displacement was significantly less in the PABPs than in the CCRPs. Comparative analysis of the displacement in the BL(posterior wall fracture line horizontal to the ground) parameter yielded no statistically significant differences between the PABP and the 5-hole CCRPs(P= 0.261).CONCLUSION PABP provides more stable fixation in acetabulum posterior wall fractures than5-hole CCRP, allowing for proximal or distal fracture line screw application without reshaping.展开更多
BACKGROUND Obstructed defecation syndrome(ODS) is a widespread disease in the world.Rectocele is the most common cause of ODS in females. Multiple procedures have been performed to treat rectocele and no procedure has...BACKGROUND Obstructed defecation syndrome(ODS) is a widespread disease in the world.Rectocele is the most common cause of ODS in females. Multiple procedures have been performed to treat rectocele and no procedure has been accepted as the gold-standard procedure. Stapled transanal rectal resection(STARR) has been widely used. However, there are still some disadvantages in this procedure and its effectiveness in anterior wall repair is doubtful. Therefore, new procedures are expected to further improve the treatment of rectocele.AIM To evaluate the efficacy and safety of a novel rectocele repair combining Khubchandani's procedure with stapled posterior rectal wall resection.METHODS A cohort of 93 patients were recruited in our randomized clinical trial and were divided into two different groups in a randomized manner. Forty-two patients(group A) underwent Khubchandani's procedure with stapled posterior rectal wall resection and 51 patients(group B) underwent the STARR procedure.Follow-up was performed at 1, 3, 6, and 12 mo after the operation. Preoperative and postoperative ODS scores and depth of rectocele, postoperative complications, blood loss, and hospital stay of each patient were documented. All data were analyzed statistically to evaluate the efficiency and safety of our procedure.RESULTS In group A, 42 patients underwent Khubchandani's procedure with stapled posterior rectal wall resection and 34 were followed until the final analysis. In group B, 51 patients underwent the STARR procedure and 37 were followed until the final analysis. Mean operative duration was 41.47 ± 6.43 min(group A) vs39.24 ± 6.53 min(group B). Mean hospital stay was 3.15 ± 0.70 d(group A) vs 3.14± 0.54 d(group B). Mean blood loss was 10.91 ± 2.52 mL(group A) vs 10.14 ± 1.86 m L(group B). Mean ODS score in group A declined from 16.50 ± 2.06 before operation to 5.06 ± 1.07 one year after the operation, whereas in group B it was17.11 ± 2.57 before operation and 6.03 ± 2.63 one year after the operation. Mean depth of rectocele decreased from 4.32 ± 0.96 cm(group A) vs 4.18 ± 0.95 cm(group B) preoperatively to 1.19 ± 0.43 cm(group A) vs 1.54 ± 0.82 cm(group B)one year after operation. No other serious complications, such as rectovaginal fistula, perianal sepsis, or deaths, were recorded. After 12 mo of follow-up, 30 patients'(30/34, 88.2%) final outcomes were judged as effective and 4(4/34,11.8%) as moderate in group A, whereas in group B, 30(30/37, 81.1%) patients' outcomes were judged as effective, 5(5/37, 13.5%) as moderate, and 2(2/37,5.4%) as poor.CONCLUSION Khubchandani's procedure combined with stapled posterior rectal wall resection is an effective, feasible, and safe procedure with minor trauma to rectocele.展开更多
Traumatic dislocation of the hip is quite rare and accounts for 2% - 5% of all dislocations. We report on a case of a bilateral posterior hip dislocation associated with symmetric acetabular fracture and two cases of ...Traumatic dislocation of the hip is quite rare and accounts for 2% - 5% of all dislocations. We report on a case of a bilateral posterior hip dislocation associated with symmetric acetabular fracture and two cases of infracotyloid dislocation. The report included 2 men and one woman. The mean age of patients was 33 years. All dislocations followed a road traffic accident. Non-operative closed reduction was achieved within 19 hours of admission. The average follow-up time was 15 months. The hips were stable, mobile, and painless;and there was no radiographic sign of avascular necrosis of the femoral head.展开更多
Purpose： Complete visualization of certain acetabular fractures of posterior wall or column with cranial extension involving superior dome from standard surgical exposures is a challenge. Osteotomy of the greater tro...Purpose： Complete visualization of certain acetabular fractures of posterior wall or column with cranial extension involving superior dome from standard surgical exposures is a challenge. Osteotomy of the greater trochanter has been used to enhance fracture visualization, especially the dome, in posterior and lateral exposures of the acetabulum, it also decreases the need for excessive muscle retraction. The purpose of the study was to investigate the outcome associated with trochanteric flip osteotomy in the management of certain acetahulum fractures. Methods： From January 2011 to December 2013, 25 displaced acetabular fractures were treated by open reduction and internal fixation. The fractures were managed using a Kocher-Langenbeck approach along with trochanteric flip osteotomy. At 3rd, 6th and 24th month follow-up, all patients had radiographic examination and underwent a final clinical evaluation based on the modified Merle d＇Auhigne and Postei score. The strength of the abductors was assessed according to the Medical Research Council （MRC） grading system. Results： Congruent reduction was achieved in all patients and all osteotomies healed within an average period of 3.8 months. All our patients were allowed full weight bearing at the end of 3 months and with no abductor lurch at the end of 6 months follow-up. There were no cases of avascular necrosis of femoral head. None of the patients had any neurovascular complication or infection by the end of the follow-up period. Conclusion： Truchanteric flip osteotomy is a very effective technique to fix certain acetabular fractures especially those with dome involvement. It is more accurate and associated with no significant com- plications compared with conventional way.展开更多
文摘Transoral robotic surgery(TORS)is a minimally invasive technique for resection of tumors of the posterior pharyngeal wall.Rarely,post-TORS cervical spondylodiscitis has been reported in the literature,with high morbidity and mortality.A 64-year-old female with underlying cervical disk disease underwent TORS resection of a posterior pharyngeal wall carcinoma without reconstruction in April 2020.Roughly one month post-operatively,the patient presented with clinical and radiographic signs of spondylodiscitis,epidural abscess,and meningitis.The patient was treated with antibiotic therapy and anterior cervical discectomy and fusion.The patient recovered without neurologic deficit.A three-month post-treatment PET-CT scan showed no evidence of residual disease.Post-operative cervical spondylodiscitis and meningitis are rare complications of TORS resection for posterior pharyngeal wall carcinomas,but the risk is increased in patients with underlying cervical disk disease.In such patients,perioperative antibiotic treatment and/or reconstruction should be considered to prevent neurologic complications and death.
文摘BACKGROUND The purpose of open reduction and internal fixation of acetabulum posterior wall fractures is to restore anatomical structure and stability of the hip joint, in order to start weight bearing as soon as possible and prevent hip arthrosis; restoration of the anatomy should preserve function of the joint as well. Although "special shaped precontoured plates" have been developed in recent years for surgical treatment of this region, studies comparing the traditional plates with the newly designed precontoured plates are lacking.AIM To evaluate the biomechanical properties of precontoured anatomic buttress and conventional curved reconstruction plates(CCRPs) for posterior wall acetabulum fracture treatment.METHODS Twelve pelvis models were created for testing plate treatment of fracture in the posterior wall of the acetabulum. These 12 pelvis models were used to create 24 hemipelvis models(experimental) by cutting from the sagittal plane and passing over the center of gravity, after which the posterior wall acetabular fractures(of similar type and size) were created. In these experimental models, the right acetabulum was fixed with a 5-hole CCRP, while the left was fixed with a precontoured anatomic buttress plate(PABP). Samples were placed through thetest device and were subjected to static load testing, with a constant testing velocity of 2 mm/min until the load reached 2.3 kN or the acetabular fixation failed. Dynamic tests were also performed with sinusoidal wave load, with a maximal load of 2.3 kN and a load ratio of 0.1.RESULTS The average stiffness values were 460.83 ± 95.47 N/mm for the PABP and 291.99± 118.58 N/mm for the 5-hole CCRP. The precontoured anatomic acetabulum buttress plates had significantly higher rigidity than the CCRPs(P = 0.022). There was a statistically significant difference between the unloaded and 2.3 kN-loaded values of AL(posterosuperior fracture line vertical to the ground surface) and CL(posteroinferior fracture line vertical to the ground surface) parameters for both the PABPs and the 5-hole CCRPs(P = 0.036 and P = 0.045, respectively).According to the static tests, the amount of total displacement was significantly less in the PABPs than in the CCRPs. Comparative analysis of the displacement in the BL(posterior wall fracture line horizontal to the ground) parameter yielded no statistically significant differences between the PABP and the 5-hole CCRPs(P= 0.261).CONCLUSION PABP provides more stable fixation in acetabulum posterior wall fractures than5-hole CCRP, allowing for proximal or distal fracture line screw application without reshaping.
文摘BACKGROUND Obstructed defecation syndrome(ODS) is a widespread disease in the world.Rectocele is the most common cause of ODS in females. Multiple procedures have been performed to treat rectocele and no procedure has been accepted as the gold-standard procedure. Stapled transanal rectal resection(STARR) has been widely used. However, there are still some disadvantages in this procedure and its effectiveness in anterior wall repair is doubtful. Therefore, new procedures are expected to further improve the treatment of rectocele.AIM To evaluate the efficacy and safety of a novel rectocele repair combining Khubchandani's procedure with stapled posterior rectal wall resection.METHODS A cohort of 93 patients were recruited in our randomized clinical trial and were divided into two different groups in a randomized manner. Forty-two patients(group A) underwent Khubchandani's procedure with stapled posterior rectal wall resection and 51 patients(group B) underwent the STARR procedure.Follow-up was performed at 1, 3, 6, and 12 mo after the operation. Preoperative and postoperative ODS scores and depth of rectocele, postoperative complications, blood loss, and hospital stay of each patient were documented. All data were analyzed statistically to evaluate the efficiency and safety of our procedure.RESULTS In group A, 42 patients underwent Khubchandani's procedure with stapled posterior rectal wall resection and 34 were followed until the final analysis. In group B, 51 patients underwent the STARR procedure and 37 were followed until the final analysis. Mean operative duration was 41.47 ± 6.43 min(group A) vs39.24 ± 6.53 min(group B). Mean hospital stay was 3.15 ± 0.70 d(group A) vs 3.14± 0.54 d(group B). Mean blood loss was 10.91 ± 2.52 mL(group A) vs 10.14 ± 1.86 m L(group B). Mean ODS score in group A declined from 16.50 ± 2.06 before operation to 5.06 ± 1.07 one year after the operation, whereas in group B it was17.11 ± 2.57 before operation and 6.03 ± 2.63 one year after the operation. Mean depth of rectocele decreased from 4.32 ± 0.96 cm(group A) vs 4.18 ± 0.95 cm(group B) preoperatively to 1.19 ± 0.43 cm(group A) vs 1.54 ± 0.82 cm(group B)one year after operation. No other serious complications, such as rectovaginal fistula, perianal sepsis, or deaths, were recorded. After 12 mo of follow-up, 30 patients'(30/34, 88.2%) final outcomes were judged as effective and 4(4/34,11.8%) as moderate in group A, whereas in group B, 30(30/37, 81.1%) patients' outcomes were judged as effective, 5(5/37, 13.5%) as moderate, and 2(2/37,5.4%) as poor.CONCLUSION Khubchandani's procedure combined with stapled posterior rectal wall resection is an effective, feasible, and safe procedure with minor trauma to rectocele.
文摘Traumatic dislocation of the hip is quite rare and accounts for 2% - 5% of all dislocations. We report on a case of a bilateral posterior hip dislocation associated with symmetric acetabular fracture and two cases of infracotyloid dislocation. The report included 2 men and one woman. The mean age of patients was 33 years. All dislocations followed a road traffic accident. Non-operative closed reduction was achieved within 19 hours of admission. The average follow-up time was 15 months. The hips were stable, mobile, and painless;and there was no radiographic sign of avascular necrosis of the femoral head.
文摘Purpose： Complete visualization of certain acetabular fractures of posterior wall or column with cranial extension involving superior dome from standard surgical exposures is a challenge. Osteotomy of the greater trochanter has been used to enhance fracture visualization, especially the dome, in posterior and lateral exposures of the acetabulum, it also decreases the need for excessive muscle retraction. The purpose of the study was to investigate the outcome associated with trochanteric flip osteotomy in the management of certain acetahulum fractures. Methods： From January 2011 to December 2013, 25 displaced acetabular fractures were treated by open reduction and internal fixation. The fractures were managed using a Kocher-Langenbeck approach along with trochanteric flip osteotomy. At 3rd, 6th and 24th month follow-up, all patients had radiographic examination and underwent a final clinical evaluation based on the modified Merle d＇Auhigne and Postei score. The strength of the abductors was assessed according to the Medical Research Council （MRC） grading system. Results： Congruent reduction was achieved in all patients and all osteotomies healed within an average period of 3.8 months. All our patients were allowed full weight bearing at the end of 3 months and with no abductor lurch at the end of 6 months follow-up. There were no cases of avascular necrosis of femoral head. None of the patients had any neurovascular complication or infection by the end of the follow-up period. Conclusion： Truchanteric flip osteotomy is a very effective technique to fix certain acetabular fractures especially those with dome involvement. It is more accurate and associated with no significant com- plications compared with conventional way.
